Early prenatal diagnosis of parapagus conjoined twins

Conjoined twinning occurs in 1/100 of monozygotic twins, 1/50,000 gestations and 1/250,000 live births. It is the consequence of a division event at the primitive streak stage of the human embryonic development, about 13-14 days after fertilisation, in monochorionic monoamniotic gestations. A healthy pregnant woman, Gravida 2 Para 1, was admitted into our Fetal Medicine Unit to perform the first trimester ultrasound. A diagnosis of conjoined parapagus twinning based on ultrasound features was made at 11 weeks of gestation, and the couple decided to terminate the pregnancy. The ultrasound showed two independent skulls and hearts, a shared spine below the thoracic level, and a shared stomach. The pathological findings were slightly different, showing two independent stomachs draining into a common duodenum. The karyotype was 46 XY. Early prenatal ultrasound may provide a window to counsel the family and to offer an early termination of pregnancy.

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Dicephalus Parapagus Conjoined Twins Diagnosed by First-Trimester Ultrasound

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/8565193 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2

Author(s):

Keiko Watanabe ◽

Masanori Ono ◽

Mayu Shirahashi ◽

Toshiyuki Ikeda ◽

Kazumi Yakubo

Keyword(s):

Prenatal Diagnosis ◽

First Trimester ◽

Conjoined Twins ◽

Ultrasound Diagnosis ◽

Optimal Management ◽

Prenatal Counseling ◽

Monochorionic Twin ◽

The Family ◽

Pregnancy And Delivery ◽

First Trimester Ultrasound

Conjoined twins are a rare phenomenon, occurring in 1% of monochorionic twin gestation, with an incidence of 1 : 50 000 to 1 : 100 000. Many conjoined twins have abnormalities incompatible with life, so early prenatal diagnosis is very important for optimal management of both pregnancy and delivery. We report a case of dicephalus parapagus conjoined twins, sharing a single heart, diagnosed at 12 weeks’ gestation. With early ultrasound diagnosis, we were able to provide appropriate and timely prenatal counseling to the family.

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First‐trimester ultrasound features associated with subsequent miscarriage: A prospective study

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/ajo.12944 ◽

2019 ◽

Vol 59 (5) ◽

pp. 641-648 ◽

Cited By ~ 4

Author(s):

Tracey J. Taylor ◽

Ann E. Quinton ◽

Bradley S. de Vries ◽

Jonathon A. Hyett

Keyword(s):

Prospective Study ◽

First Trimester ◽

A Prospective Study ◽

First Trimester Ultrasound ◽

Ultrasound Features

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Monozygotic Twins Discordant for Trisomy 13

Pediatric and Developmental Pathology ◽

10.1177/1093526616686471 ◽

2017 ◽

Vol 20 (4) ◽

pp. 340-347 ◽

Cited By ~ 7

Author(s):

Patrick McFadden ◽

Sarah Smithson ◽

Robert Massaro ◽

Jialing Huang ◽

Gail T Prado ◽

...

Keyword(s):

Uniparental Disomy ◽

Monozygotic Twins ◽

First Trimester ◽

Nuchal Translucency ◽

Trisomy 13 ◽

Ultrasound Finding ◽

Umbilical Cord Cyst ◽

First Trimester Ultrasound ◽

Mosaic Trisomy ◽

Increased Nuchal Translucency

Monozygotic twins with discordant karyotypes for trisomy 13 are rare. We report a case of a spontaneously conceived pregnancy who presented with first-trimester ultrasound finding of umbilical cord cyst and increased nuchal translucency in Twin A and no abnormalities in Twin B. Amniocentesis revealed 47,XY,+13 karyotype in Twin A and 46,XY karyotype in Twin B. Selective fetal reduction was performed for Twin A. Twin B was delivered at 32 weeks gestation with normal phenotype. Peripheral blood karyotype revealed 15% mosaicism for trisomy 13 and skin fibroblast revealed 46,XY karyotype. The surviving twin will be monitored for potential complication of uniparental disomy 13 and mosaic trisomy 13. This case reinforces the need for early ultrasound and nuchal translucency measurements, especially in twin gestations.

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P44.14: Jarcho-Levin Syndrome: second and first trimester ultrasound features

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.4966 ◽

2007 ◽

Vol 30 (4) ◽

pp. 621-622 ◽

Cited By ~ 1

Author(s):

M. Herrera ◽

M. Rebolledo ◽

M. Beltran

Keyword(s):

First Trimester ◽

First Trimester Ultrasound ◽

Ultrasound Features

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Two Corpora Lutea Seen at 6–13 Weeks' Gestation Infers Dizygosity Among Spontaneous Same-Sexed Dichorionic Twins

Twin Research and Human Genetics ◽

10.1375/twin.12.2.180 ◽

2009 ◽

Vol 12 (2) ◽

pp. 180-182 ◽

Cited By ~ 2

Author(s):

Jean Woo ◽

Stephen Tong ◽

Megan J. Campbell ◽

Leanne Wallace ◽

Simon Meagher ◽

...

Keyword(s):

Microsatellite Markers ◽

Corpus Luteum ◽

Case Series ◽

Monozygotic Twins ◽

First Trimester ◽

Corpora Lutea ◽

Dna Genotyping ◽

Twin Pregnancies ◽

First Trimester Ultrasound

AbstractCurrent ultrasound techniques can accurately determine the chorionicity of twins, but not zygosity. We previously proposed that the zygosity of spontaneously conceived twins can be determined at early ultrasound, where 2 corpora lutea infers dizygosity, and 1 implies monozygosity. Here we did a case series, comparing zygosity predicted using this method with definitive DNA genotyping of twins after birth. We retrospectively identified 14 ultrasound reports of spontaneous twin pregnancies at 6(+0 days) to 13+6 weeks' gestation, where both ovaries were seen and the number of corpora lutea documented. We visited all twin pairs, obtained buccal smears, and determined zygosity by genotyping 9 independent microsatellite markers. All 8 cases where 2 corpora lutea were seen were dizygotic pregnancies. One further case where 3 corpora lutea were seen was also dizygotic. All 3 sets of monozygotic twins had 1 corpus luteum. There were 2 cases incorrectly assigned, where 1 corpus luteum was seen in dizygotic pregnancies. We conclude if 2 corpora lutea are seen at a first trimester ultrasound of spontaneously conceived dichorionic twins, they appear to be almost certainly dizygotic. However, if 1 corpus luteum is seen in dichorionic twins, zygosity cannot be determined with certainty since it is either monozygotic, or dizygotic where a second corpus luteum has been missed.

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Delivery of Retained Second Twin in Case of Omphalopagus Conjoined Twins: Abdominovaginal Approach

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/9319721 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Wondimagegnehu Sisay Woldeyes

Keyword(s):

Rare Complication ◽

Monozygotic Twins ◽

Conjoined Twins ◽

Unique Challenge ◽

Present Case Report ◽

Early Gestation ◽

The Family ◽

First Time ◽

Unborn Baby ◽

Second Twin

Conjoined twin is a rare complication of monozygotic twins resulting from incomplete splitting of an embryo into two separate twins or early secondary fusion of two originally separated embryos. When diagnosed at early gestation, one can get adequate time to counsel the family on whether to continue with the pregnancy and proper intervention can be planned. On the other hand, undiagnosed cases may be first recognized in labor after they have caused labor-related complications. In the present case report, an undiagnosed case of a conjoined twin has presented in labor followed by delivery of one baby with the retention of the second baby. This presented a unique challenge to the managing team and required hysterotomy to effect delivery of the unborn baby. We report this case to highlight the importance of early diagnosis of a conjoined twin. On another hand where this does not happen and a conjoined twin is suspected for the first time after it has caused labor-related complications, the management should be individualized based on the clinical circumstance.

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